Did you know that around 25% of pregnancies in Singapore end up in miscarriage?

As common as it may sound, you cannot help but feel devastated when this happens to you. As you grieve, you might find yourself going through feelings and emotions such as:

•  Shock
•  Guilt and feeling as if you’ve failed as a mother
•   Fear of getting pregnant again and miscarrying
•  Loss of identity (you become attached to motherhood when you get pregnant)
•  Loss of control, confusion, and loneliness

The truth is, you are not responsible for your miscarriage. And yes, you are justified to mourn your loss even if you never got to hold the baby in your arms.

But with knowledge comes power, and the more you know about miscarriages, the more prepared you will be to handle them.

This article will help you understand everything about miscarriage. From what it is, the signs and symptoms, the treatments you can seek should it happen to you, and what you can do after to help you cope with the miscarriage.

What is a Miscarriage?

Miscarriage, medically known as spontaneous abortion, refers to the loss of pregnancy before the 20th week. For every ten known pregnancies, 1 – 2 fetuses end in miscarriage. The actual percentage could be higher because some losses happen even before a woman is aware of the pregnancy.

75 to 80 percent of miscarriages in Singapore occur in the first trimester before the 12th week. Most of these result from the fetus not developing properly. 

Any loss that happens after 13 weeks, or in the second trimester, is called a late miscarriage.

What Causes a Miscarriage?

Even though the unexpected loss is attributed to other risks, it commonly results from the failure of the fetus to develop normally.

The process of combining the female and male cell to form a baby is complicated, and when something goes wrong, the development of the fetus is at stake

You should never blame yourself for something you think you did or didn’t do; the complexity of all the processes going on in your body during pregnancy, may at many times, be way beyond your control.

Some of the factors that could contribute to a miscarriage include:

Chromosome abnormalities

Both the woman and the man each contribute a pair of chromosomes to develop the fetus. These chromosomes hold the genes. If either of them produces an extra or less chromosome, it will result in an abnormal combination. These chromosomal abnormalities may lead to:

• Blighted ovum – where the embryo doesn’t form at all

• Molar pregnancy – where the father contributes both chromosomes, so the foetus fails to develop

• Partial molar pregnancy – where the mother gives her set, and the father gives two sets. It is also associated with an abnormal placenta.

• Intrauterine fetal demise – a formed embryo stops developing and dies without showing any symptoms of miscarriage

Underlying health conditions of the mother

Sometimes, the mother could be having health issues that can affect fetal development, such as:

• Uncontrolled diabetes
• Malnutrition
• Severe hypertension
• Thyroid disease
• Hormonal problems
• Use of medications such as blood thinners
• Trauma
• Smoking, alcoholism, and drug abuse.
• Cervix and uterus complications

However, to clear some misconceptions, exercises and sexual intercourse are not part of the risk factors.

Work also doesn’t affect the fetus unless you have other complications that will prompt your gynecologist to advise you against intensive activities. 

Risk factors

Some risk factors might increase your chances of getting a miscarriage. These include:

• Age – women below 35 years are at a lower risk of having a miscarriage than those above. The risk increases from 35 onwards, and by age 45, the risk is at 80%.

• Weight –  overweight and underweight women are prone to miscarriages

• Previous miscarriages

• Being exposed to harmful radiations and chemicals

What are the notable symptoms of miscarriage in early pregnancy?

Symptoms vary according to your stage of pregnancy. However, common ones include:

• Vaginal bleeding
• Heavy spotting
• Tissue/fluid discharge from your vagina
• Excruciating abdominal pain/ cramping
• Lower back pain

Note that it doesn’t necessarily mean that every one of these symptoms points to a miscarriage. Some women experience spotting or bleeding, but they still carry their pregnancy to term.

However, if you experience any of them, you need to seek medical attention immediately to ascertain the cause of your symptoms as they may indicate an underlying problem.

If you find yourself passing out tissue from your vagina, you may need to collect it in a container and take it to your doctor. It will help in examinations and diagnoses.

Late pregnancy miscarriage

This happens between week 13 and week 20 of pregnancy. The causes can be similar, but its symptoms can differ a bit from the early pregnancy miscarriage.

In the second trimester, the fetus is more developed, and mostly the mother is aware of the pregnancy.

Symptoms of a miscarriage at this stage may include:

• Vaginal bleeding/ cramping
• Inability to feel the fetus’ movement
• Fluid/ tissue from the vagina
• Severe pain in the abdomen, and/ or lower back

Missed miscarriage

Sometimes, you may have a miscarriage without experiencing any of the signs and symptoms mentioned above. This is called a missed miscarriage.

How is a missed miscarriage diagnosed?

The standard method is through a blood test done on a woman during early pregnancy to check the level of hCG (human chorionic gonadotropin).

This is a hormone that the body produces during pregnancy. In the first weeks, that hormone is supposed to rise.

If the quantity/concentration stops rising, but instead it drops, that raises a red flag for a possible missed miscarriage.

Another way to detect is when the doctor is unable to hear the heartbeat of the fetus using the heart rate monitor towards the 12th week of pregnancy.

An ultrasound at around 20 weeks could also reveal that the fetal heart rate has stopped, indicating a miscarriage.

Is it miscarriage or monthly flow?

Some miscarriages can occur so early in pregnancy even before you realize you are pregnant. You end up mistaking miscarriage bleeding for the usual monthly flow.

You need to consider several factors to tell them apart. They include:

• The intensity of the bleeding- for a miscarriage, it will be heavier with clots.
• Duration –the symptoms of a miscarriage last longer than periods
• The severity of symptoms- the abdominal and back pain worsens with time

Treatment options for miscarriages

There are several treatments for miscarriages available in Singapore. However, your gynae will choose the best one for you, depending on the type of miscarriage that you had.

If you had a complete miscarriage leaving no tissues in your womb, you might not need any treatment.

But if  tissues remained in your womb, these treatment options could be adopted:

• Expectant management – wait for the tissues to flow out naturally.

• Medical management – doctor prescribes to you medicines to use to help you expel the remaining tissues.

• Surgery management – the tissues are removed through a surgical procedure using a light anesthetic, and you can go home that same day.

Periods after miscarriage

Two weeks after a miscarriage, your ovaries will resume producing eggs. So you should resume your periods within four weeks.

You will need to visit your doctor for a check-up by the sixth week to see whether your uterus is back to normal.

During the visit, you may ask more about your pathology results or any troubling concerns that you might have. 

After a Miscarriage…

Grief and sadness after a miscarriage are normal. Don’t suppress your grief. Instead, mourn for as long as it helps, but also be careful not to allow it to overwhelm you.

Find comfort in your friends and relatives, join support groups and forums, and never be afraid to ask for help. Talking about it and sharing your feelings will help you heal.

It always helps to know that you are not alone and that it is ultimately not your fault. After all, a miscarriage is not an indication of more to come.

Now that you have learnt all about miscarriages, here’s hoping that this information will give you power, comfort, and resilience!